Article excerpt

Client perceptions of their therapists' cultural humility have been associated with positive therapy outcomes; however, it is unclear whether these positive effects are consistent across clients. In particular, this study examines the extent to which clients' religious commitment moderates the association between their perceptions of their therapists' cultural humility and therapy outcomes. The sample included 45 clients, all of whom identified their religion/spirituality as the most salient aspect to their cultural identity. The results demonstrated that perceptions of cultural humility were positively associated with therapy outcomes. However, this effect was moderated by clients' religious commitment. The relationship between perceived cultural humility and outcomes was positive for clients with higher religious commitment, whereas it was not different from zero for clients with lower religious commitment. Implications for research, theory, and practice are offered.

Therapy is a healing practice. Hope, inspiration, and relief can come from a variety of sources, including clients' religion/spirituality (1) (R/S; Frank & Frank, 1991). Indeed, clients' R/S can be central to many facets of their identity, social networks, coping styles, and ways in which they understand psychological distress (Carone & Barone, 2001; Cragun & Friedlander, 2012; Frazier & Hansen, 2009; Wampold, 2007). Thus, it is not surprising that treatments that integrate R/S aspects can have beneficial effects. For example, a recent meta-analysis of 46 studies with over 3,000 clients found that religiously adapted treatments outperformed secular treatments on psychological outcomes (d = 0.26) and more so for R/S outcomes (d = 0.41; see Worthington, Hook, Davis, & McDaniel, 2011).

Although adapting treatments can be beneficial, it is also important to understand how therapists approach integrating clients' R/S in therapy. Therapists may be able to enhance their engagement with clients by attending to, honoring, and integrating clients' R/S commitment into the therapy process, which in turn can ultimately enhance treatment outcomes (e.g., Cragun & Friedlander, 2012; Hook, Davis, Owen, Worthington, & Utsey, 2013; Post & Wade, 2009). This therapeutic process embodies the essence of what it means for therapists to have a strong multicultural orientation (MCO; Owen, Tao, Leach, & Rodolfa, 2011). More specifically, therapists' MCO includes three aspects, including therapists' (a) cultural humility, (b) ability to create opportunities to discuss and integrate clients' cultural heritage into the therapy process, and (c) comfort or ease of engaging in these discussions (Owen, 2013). In this study, we will examine one aspect of therapists' MCO, the degree to which clients perceive their therapist as culturally humble towards their R/S commitment.

Cultural humility reflects a way of being, wherein therapists maintain an other-oriented perspective that involves respect, lack of superiority, and attun-ement to clients' cultural heritage (Hook et al., 2013). Although this definition seems to be tantamount to what it means to be a therapist, some clients do not view their therapist as being supportive towards their cultural identity (e.g., Constantine, 2007; Owen, Imel et al., 2011; Owen, Tao,. & Rodolfa, 2010). Yet, when clients perceive their therapist as being more culturally humble, they typically report being more engaged in sessions (i.e., the working alliance) as well as having better therapy outcomes (Hook et al., 2013). For example, in a meta-analysis of five samples (1000 clients), clients' perceptions of their therapists' cultural humility (across cultural identities) notably overlapped with clients' ratings of the alliance (41% of shared variance) and accounted for approximately 4.4% of the variance in therapy outcomes (e.g., psychological distress; Owen, in press). Quite simply, therapists' cultural humility is foundational to clients' engagement in meaningful and purposeful work and could enhance treatment outcomes. …